Provider Demographics
NPI:1902940638
Name:HARGIS, GREG (FNP)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:HARGIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-0247
Mailing Address - Country:US
Mailing Address - Phone:931-268-3224
Mailing Address - Fax:
Practice Address - Street 1:5751 BRADFORD HICKS DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-2237
Practice Address - Country:US
Practice Address - Phone:931-823-3030
Practice Address - Fax:931-823-3018
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928190Medicaid
TN4090152OtherBLUE CROSS BLUE SHEILD
TNQ12118Medicare UPIN
TN3928190Medicare ID - Type Unspecified